Clinical Coding Appeals Nurse

R1 RCM; United States; Sur place; USD 65 000 - 117 000; Plein temps

Résumé du poste

R1 RCM Inc. is seeking a Clinical Coding Appeals Nurse to review medical records and draft appeals of denied and underpaid claims.

You will ensure correct coding, draft persuasive appeal letters, and provide coding change recommendations based on ICD-9/10-CM, PCS, CPT, HCPCS, and NCCI guidelines. The role requires reviewing diverse hospital documentation, with MS Office proficiency, and offers a remote, independent, production-driven work environment.

Qualifications

• Bachelor's Degree in Nursing is required.
• 5 years of inpatient clinical experience.
• Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC).
• Active Registered Nurse is strongly preferred. (LPNs with acute inpatient care experience considered).

Responsabilités

• Review and interpret medical records to appeal denied and underpaid claims.
• Apply clinical judgment for DRG downgrades after Clinical Validation Review.
• Draft appeal letters using ICD-9/10-CM & PCS, CPT, HCPCS, and NCCI guidance.
• Ensure all appeals meet internal and external deadlines.

Connaissances

Inpatient clinical experience

CCS - AHIMA

CPC - AAPC

Active RN preferred

Formation

Bachelor's Degree in Nursing

Outils

MS Office

Adobe

Excel

Description du poste

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Clinical Coding Appeals Nurse, you will help review and interpret medical records to draft appeals of denied and underpaid claims. Every day you will review medical records to ensure appropriate coding of removed or revised diagnosis and procedure codes. Then you will draft appeal letters based on clinical judgment and knowledge and make coding change suggestions to our clients based on ICD-9/10 CM & PCS, CPT, HCPCS, and NCCI guidance. To thrive in this role, you must have experience identifying different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, itemized bills, hospital account notes, appeal letters, and denial/approval letters. Proficiency in basic computer skills (proficiency in MS office tools - Adobe, Excel) is essential for excelling in this remote, independent, production-driven position.

Here’s what you will experience working as a Clinical Coding Appeals Nurse:

• Review and interpret medical records to appeal denied and underpaid claims.
• Apply clinical judgment and knowledge for DRG downgrades performed because of a Clinical Validation Review by an insurer or third-party auditor.
• Draft appeal letters that are well-written, logically structured, and persuasive, utilizing ICD-9/10 CM & PCS, CPT, HCPCS, NCCI guidance.
• Ensure that all appeals are completed promptly to ensure internal and external compliance deadlines are met.

Required Skills

• Bachelor's Degree in Nursing is required.
• 5 years of inpatient clinical experience
• Certified Coding Specialist (CCS - AHIMA) or Certified Professional Coder (CPC - AAPC)
• Active Registered Nurse is strongly preferred. (LPNs with acute, inpatient care clinical experience will be considered in place of an RN, based on clinical experience and certifications).

For this US-based position, the base pay range is $65,000.00 - $116,747.20 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

To learn more, visit: R1RCM.com

Visit us on Facebook